*Department of Anesthesiology, †First Department of Critical Care, Medical School, University of Athens, and ‡Biochemical Laboratory, Evangelismos Hospital, Athens, Greece.
Shock. 2013 Oct;40(4):274-80. doi: 10.1097/SHK.0b013e3182a35de5.
S100B protein, an acknowledged biomarker of brain injury, has been reported to be increased in hemorrhagic shock. Also, acute hemorrhage is associated with inflammatory response. The aim of this study was to investigate the concentrations of serum S100B and the potential relationships with interleukin 6 (IL-6), severity of tissue hypoperfusion, and prognosis in patients admitted for surgical control of severe hemorrhage. Patients undergoing elective abdominal aortic aneurysm surgery participated as control subjects. Serum samples were drawn before, at the end of surgery, and after 6 and 24 h. Sixty-four patients with severe hemorrhage (23 trauma and 41 nontrauma) and 17 control subjects were included. Increased preoperative concentrations of S100B protein (1.70 ± 2.13 and 0.81 ± 1.23 μg/L) and IL-6 (241 ± 291 and 226 ± 238 pg/mL) were found in patients with traumatic and nontraumatic reason, respectively, and remained elevated throughout 24 h. Compared with nontrauma, trauma patients exhibited higher preoperative S100B levels (P < 0.05). Overall mortality was 47%. In control subjects, preoperative S100B and IL-6 levels were within normal limits and increased at the end of surgery (P < 0.001 and P < 0.01, respectively). Preoperative S100B correlated with IL-6 (r = 0.78, P < 0.01), arterial lactate (r = 0.50, P < 0.01), pH (r = -0.45, P < 0.01), and bicarbonate (r = -0.40, P < 0.01). Multiple analysis revealed that preoperative S100B in trauma and lactate in nontrauma patients were independently associated with outcome. In predicting death, preoperative S100B yielded receiver operator characteristics curve areas of 0.75 for all patients and 0.86 for those with trauma. These results indicate that severe hemorrhage in patients without brain injury is associated with increased serum levels of S100B, which correlates with IL-6 and tissue hypoperfusion. Moreover, the predictive ability of S100B for mortality, suggests that it could be a marker of potential clinical value in identifying, among patients with severe hemorrhage, those at greater risk for adverse outcome.
S100B 蛋白是公认的脑损伤生物标志物，已被报道在出血性休克中增加。此外，急性出血与炎症反应有关。本研究的目的是研究血清 S100B 的浓度及其与白细胞介素 6（IL-6）、组织低灌注严重程度和接受手术控制严重出血的患者预后之间的潜在关系。接受择期腹主动脉瘤手术的患者作为对照。在手术前、手术结束时以及术后 6 小时和 24 小时抽取血清样本。纳入 64 例严重出血患者（23 例创伤和 41 例非创伤）和 17 例对照。创伤和非创伤原因患者术前 S100B 蛋白（1.70±2.13 和 0.81±1.23μg/L）和 IL-6（241±291 和 226±238pg/mL）浓度升高，并持续升高 24 小时。与非创伤相比，创伤患者术前 S100B 水平更高（P<0.05）。总死亡率为 47%。在对照组中，术前 S100B 和 IL-6 水平在正常范围内，并在手术结束时升高（P<0.001 和 P<0.01）。术前 S100B 与 IL-6（r=0.78，P<0.01）、动脉乳酸（r=0.50，P<0.01）、pH（r=-0.45，P<0.01）和碳酸氢盐（r=-0.40，P<0.01）相关。多元分析显示，创伤患者术前 S100B 和非创伤患者的乳酸与结局独立相关。在预测死亡方面，所有患者术前 S100B 的受试者工作特征曲线面积为 0.75，创伤患者为 0.86。这些结果表明，无脑损伤的严重出血患者与血清 S100B 水平升高有关，该水平与 IL-6 和组织低灌注有关。此外，S100B 对死亡率的预测能力表明，它可能是一种有潜在临床价值的标志物，可用于识别严重出血患者中那些发生不良结局风险较高的患者。
